Prospective assessment of inter- or intra-fractional variation according to body weight or volume change in patients with head and neck cancer undergoing radiotherapy

This study aimed to prospectively investigate the association between body weight (ΔBW) or body volume variations (ΔBV) and inter- or intra-fractional variations (Δ(inter) or Δ(intra)) in patients with head and neck cancer (HNC) undergoing radiotherapy (RT). This study enrolled patients with HNC from December 2015 to December 2017. All patients underwent curative intensity-modulated RT (IMRT) either as definitive or adjuvant treatment. Six-dimensional inter- and intra-fractional variations (Δ(inter) and Δ(intra)) were obtained with ExacTrac (BrainLAB, Feldkirchen, Germany) system. BV was measured 7.5 cm cranio-caudally from the centre using cone beam computed tomography. The BW, BV, and Δ(inter) were calculated based on the value obtained on the first treatment day after each simulation. Both Δ(inter) and Δ(intra) were considered in calculating the optimal margins for planning target volume (PTV), which was calculated using van Herk’s formula. In total, 678 fractions with 39 simulations in 22 patients were analysed. The average ΔBW and ΔBV was -0.43±1.90 kg (range, -7.3 to 5.0) and -24.34±69.0 cc (range, -247.15 to 214.88), respectively. In correlation analysis, Δ(intra) was more associated with ΔBW or ΔBV than Δ(inter). Receiver operating characteristic analysis showed Δ(intra) could differentiate ΔBW from ΔBV, while Δ(inter) could not. The optimal margins for PTV considering both Δ(inter) and Δ(intra) were 3.70 mm, 4.52 mm, and 5.12 mm for the right-left, superior-inferior, and anterior-posterior directions, respectively. In conclusion, the PTV margin of 6 mm for anterior-posterior direction and 5 mm for the other directions were needed. ΔBW or ΔBV correlated with Δ(intra) rather than Δ(inter). Therefore, ΔBW or ΔBV should be assessed for accurate IMRT in patients with HNC.